Vascular dementia (Vascular cognitive impairment)

Summary

Vascular dementia (VD) describes gradual cognitive decline caused by small or large vessel disease. Important risk factors include hypertension, diabetes mellitus, hyperlipidemia, and advanced age. Large vessel changes primarily lead to thrombotic and/or embolic vascular occlusion, resulting in localized infarctions. In contrast, small vessel changes generally lead to more diffuse lesions. Common symptoms are cognitive impairment, motor disorders and changes in behavior. The severity of symptoms and the mode of onset (insidious or sudden) depend on the number of vascular events and the extent of cerebral damage. Vascular dementia is primarily a clinical diagnosis that is supported by evidence of cerebrovascular lesions on imaging. Management consists of treating underlying conditions (e.g., hypertension) and, in some cases, antiplatelet drugs.

Large vessel disease

Usually in the form of repeated cortical ischemic events → progressive damage to neural networks (multi-infarct dementia).

If the affected area is large and/or significant enough (strategic infarctions ), a single ischemic event may suffice to bring on VD (single-infarct dementia)

References:[1][2][3][4]

Clinical features

Symptoms depend on the location of ischemic events and therefore vary widely between individuals, but a progressive impairment of daily life is common. Because of the diverse clinical picture, the term “vascular cognitive impairment” is gaining popularity over VD .